This program provides under served, at risk youth an opportunity to participate in the club and its programs. To get started, fill out the application below. Scholarship Application Contact Information First Name * Last Name * Date of Birth * Month 1 2 3 4 5 6 7 8 9 10 11 12 / Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / Year 202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971 Street Address * City * Zip / Post Code * Home Phone * Cell Phone E-mail Address * School * Name of Parent or Guardian * Relationship * Please explain in a few sentences why you are requesting a scholarship. * Please tell us why you would like to participate in our program. * Personal References Personal Reference #1 Name * Relationship * Phone Number * Personal Reference #2 Name * Relationship * Phone Number * Submit Scholarship Application